1891809679 NPI number — FREEMAN-OAK HILL HEALTH SYSTEM

Table of content: (NPI 1891809679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891809679 NPI number — FREEMAN-OAK HILL HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREEMAN-OAK HILL HEALTH SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FREEMAN HEALTH SYSTEM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891809679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1102 W 32ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-3503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-347-1111
Provider Business Mailing Address Fax Number:
417-347-9311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 W 32ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-3503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-347-1111
Provider Business Practice Location Address Fax Number:
417-347-9311
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRADDY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
417-347-6678

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 540565207 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 338810401 . This is a "G FREEMAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 359153806 . This is a "STAMPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0252820013 . This is a "MEDICARE DMERC NORIDIAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 32037 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100099600G , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100711500O , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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